Foot & Ankle Specialties
A bunion is a painful bony bump that develops on the inside of the foot at the big toe joint. Bunions are often referred to as hallux valgus. Bunions develop slowly. Pressure on the big toe joint causes the big toe to lean toward the second toe. Over time, the normal structure of the bone changes, resulting in the bunion bump. This deformity will gradually increase and may make it painful to wear shoes or walk. Anyone can get a bunion, but they are more common in women. Many women wear tight, narrow shoes that squeeze the toes together—which makes it more likely for a bunion to develop, worsen and cause painful symptoms.
A bunionette, or "tailor's bunion," occurs on the outside of the foot near the base of the little toe. Although it is in a different spot on the foot, a bunionette is very much like a bunion. You may develop painful bursitis and a hard corn or callus over the bump.
Lesser Toe Deformities
Lesser toe deformities are caused by alterations in normal anatomy that create an imbalance between the intrinsic and extrinsic muscles. Causes include improper shoe wear, trauma, genetics, inflammatory arthritis, and neuromuscular and metabolic diseases. Typical deformities include mallet toe, hammer toe, claw toe, curly toe, and crossover toe. Abnormalities associated with the metatarsophalangeal (MTP) joints include hallux valgus of the first MTP joint and instability of the lesser MTP joints, especially the second toe.
The term neuroma is given to a condition where the forefoot becomes painful. The condition is more common in ladies in the 5th decade and shoewear is felt to be an aggravating factor. Patients typically complain of a “burning aching” type pain in the forefoot, which is worse in tight or high heeled shoes. It is said that you can tell the neuroma woman in the shopping centre because she is the woman with her shoe off rubbing her foot.
Metatarsalgia is a term used to describe a group of forefoot conditions that cause pain, burning or discomfort under the ball of the foot or in the metatarsal bones. Each foot has five metatarsal bones that run from the arch of your foot to your toe joints.
Toe and forefoot fractures often result from trauma or direct injury to the bone. Fractures can also develop after repetitive activity, rather than a single injury. This is called a "stress fracture." Stress fractures are small cracks in the surface of the bone that may extend and become larger over time. Stress fractures are typically caused by repetitive activity or pressure on the forefoot. They are common in runners and athletes who participate in high-impact sports such as soccer and basketball.
Big Toe Arthritis: Joint Replacement and Fusions
The most common site of arthritis in the foot is at the base of the big toe. This joint is called the metatarsophalangeal, or MTP joint. It's important because it has to bend every time you take a step. If the joint starts to stiffen, walking can become painful and difficult. In the MTP joint, as in any joint, the ends of the bones are covered by a smooth articular cartilage. If wear-and-tear or injury damage the articular cartilage, the raw bone ends can rub together. A bone spur, or overgrowth, may develop on the top of the bone. This overgrowth can prevent the toe from bending as much as it needs to when you walk. The result is a stiff big toe, or hallux rigidus.
Rheumatoid Foot Disorders
Rheumatoid arthritis is a disease that affects 0.3 percent to 1.5 percent of the general population. Foot deformities are a major source of pain and disability. The frequency and degree of problems are directly related to the disease duration (i.e., the longer the disease, the greater the deformity). A typical patient with rheumatoid forefoot disease may have components of hallux valgus (bunion deformity), metatarsalgia (pain over the ball of foot with loss of fat pad) and hammertoe deformities. There may be painful thick callous areas under the ball of the foot or on the tops of the toes.
Diabetic Foot Disorders / Charcot Arthropathies
Diabetes is a condition of elevated blood sugar that affects about 6 percent of the population in the United States, or about 16 million people. Diabetic foot problems are a major health concern and are a common cause of hospitalization.
Most foot problems that people with diabetes face arise from two serious complications of the disease: nerve damage and poor circulation. One of the more critical foot problems these complications can cause is Charcot arthropathy, which can deform the shape of the foot and lead to disability.
Ankle Sports injuries
Ankle injuries are often thought of as sports injuries. But you don't have to be an athlete or even a "weekend warrior" to turn your ankle and hurt it. Something as simple as walking on an uneven surface can cause a painful, debilitating sprain.
Ankle injuries can happen to anyone at any age. However, men between 15 and 24 years old have higher rates of ankle sprain, compared to women older than age 30 who have higher rates than men. Half of all ankle sprains occur during an athletic activity. Every day in the U.S., 25,000 people sprain their ankle. And more than 1 million people visit emergency rooms each year because of ankle injuries. The most common ankle injuries are sprains and fractures, which involve ligaments and bones in the ankle. But you can also tear or strain a tendon.
Symptomatic osteochondral ankle defects often require surgical treatment. An osteochondral ankle defect is a lesion of the talar cartilage and subchondral bone mostly caused by a single or multiple traumatic events, leading to partial or complete detachment of the fragment. The defects cause deep ankle pain associated with weightbearing. Impaired function, limited range of motion, stiffness, catching, locking and swelling may be present. These symptoms place the ability to walk, work and perform sports at risk.
Complex Ankle/Foot Deformity Correction
Complex foot and ankle deformity can be difficult to treat with conventional surgical approaches. Deformity and instability of the ankle can be seen in Charcot arthropathy, and in other neuropathic conditions. External fixation with acute or gradual correction of deformities can be used to safely treat complex ankle deformity.
Following ankle trauma, infection, or even a failed ankle replacement, there is often significant bone loss around the ankle.
Ankle replacement, or ankle arthroplasty, is a surgical procedure to replace the damaged articular surfaces of the human ankle joint with prosthetic components. This procedure is becoming the treatment of choice for patients requiring arthroplasty, replacing the conventional use of arthrodesis, i.e. fusion of the bones. The restoration of range of motion is the key feature in favor of ankle replacement with respect to arthrodesis. However, clinical evidence of the superiority of the former has only been demonstrated for particular isolated implant designs.
Ankle fusion is a type of surgery to fuse the bones of your ankle into one piece. It’s also known as ankle arthrodesis. The surgery is usually done to treat arthritis in the ankle. The ankle joint is also called the tibiotalar joint. It’s where the shinbone (tibia) rests on top of a bone of the foot called the talus. The ankle also includes the subtalar joint. This is where 2 foot bones called the talus and the calcaneus meet. Arthritis can affect these 2 joints in the foot. Over time, the smooth cartilage on the surface of the bones wears away. This results in pain, inflammation, and swelling in your joint.Ankle fusion is a surgery to fuse 2 or more bones in the ankle.
Midfoot arthritis is characterized by pain and swelling in the midfoot, aggravated by standing and walking. There is often an associated bony prominence on the top of the foot. Usually the symptoms develop gradually over time, although it can occur following a major midfoot injury, such as a Lisfranc injury.
Midfoot Sports injuries and stress fractures
Many stress fractures are overuse injuries. They occur over time when repetitive forces result in microscopic damage to the bone. The repetitive force that causes a stress fracture is not great enough to cause an acute fracture — such as a broken ankle caused by a fall. Overuse stress fractures occur when an athletic movement is repeated so often, weight-bearing bones and supporting muscles do not have enough time to heal between exercise sessions. A bone is in a constant state of turnover—a process called remodeling. New bone develops and replaces older bone. If an athlete's activity is too great, the breakdown of older bone occurs rapidly — it outpaces the body's ability to repair and replace it. As a result, the bone weakens and becomes vulnerable to stress fractures.
Flat feet (also called pes planus or fallen arches) is a postural deformity in which the arches of the foot collapse, with the entire sole of the foot coming into complete or near-complete contact with the ground. An estimated 20–30% of the general population have an arch that simply never develops in one or both feet.
High Arched Feet
Pes cavus, also known as high arch, is a human foot type in which the sole of the foot is distinctly hollow when bearing weight. That is, there is a fixed plantar flexion of the foot. A high arch is the opposite of a flat foot and is somewhat less common.
Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the joint through a small incision. Arthroscopic procedures can be performed during ACL reconstruction.
Tendoscopy (treating tendon and ligaments with camera/endoscopy)
Tendoscopy is a procedure that allows an orthopaedic surgeon to see the inside of a tendon sheath to treat tendon disorders of the foot and ankle. Tendoscopy is very similar to arthroscopy. A small camera and special instruments are placed through small incisions along the course of a tendon. Sterile fluid is used to expand the sheath and provide direct exposure to the tendon. The goal of tendoscopy is to treat tendon disorders without using large incisions. Patients have less pain and smaller scars than with traditional open surgery. Patients also can return to work and exercise sooner with this procedure versus open surgery.
Hindfoot Sports Injuries
The hindfoot bears and distributes your body weight across your foot when you stand or walk. It takes a lot of force to fracture the bones in the hindfoot. A fracture is a broken bone. Injuries most frequently result from car crashes or falls from a significant height. Fractures may occur in the heel or the bone located on top of the heel. Hindfoot fractures take a long time to heal, with or without surgery.
Hindfoot arthritis can be caused by degeneration (osteoarthritis) or inflammation (e.g. rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis). In both cases the cartilage, which is the shiny white gristle that lines and articulates the joint, becomes damaged. This causes bone to rub on bone, which is painful. Osteoarthritis is usually secondary to damage to the joint, for example as a result of previous fracture, repeated sprains of the ankle, malalignment of the joint or infection. Excess body weight can overload a joint and worsen the symptoms of arthritis.
Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical techniques that limit the size of incisions needed and so lessen wound healing time, associated pain and risk of infection. Surgery by definition is invasive and many operations requiring incisions of some size are referred to as open surgery, in which incisions made can sometimes leave large wounds that are painful and take a long time to heal. Minimally invasive procedures have been enabled by the advance of various medical technologies.